Provider Demographics
NPI:1801955166
Name:BOB'S DRUGS LLC
Entity type:Organization
Organization Name:BOB'S DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-854-6605
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421-0266
Mailing Address - Country:US
Mailing Address - Phone:231-854-6605
Mailing Address - Fax:231-854-0068
Practice Address - Street 1:194 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-7500
Practice Address - Country:US
Practice Address - Phone:231-854-6605
Practice Address - Fax:231-854-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301002400333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2311140Medicaid
MI872791989Medicaid
MI2311140Medicaid